05137 (MFD5)Building
Address 78-185 CrinSon D
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 777 S. Main St., Suite 106
City Zip Tel.
Orange 92656 i14-547-81356
Contractor
Same
State Lic.331261 I LC.ic. # 1177
8 Classif.
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 alicensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of tm he Business and Professions Code, and my license is in full force and
effect ,
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness and Hv/essians; Lode: Any city or county which requires a
permit to constnict, after, improve, dernc&h, or cepa: any sbuGh re, poor to its issuance also
requires the applicant for such peri to tie a signed statement that hes licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therelmm, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civi penalty of net more than ewe tended dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractors License Law Wes not apply to an owner of property who
builds or 'reproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. fl, however, the building
or improvement is sold within ane year of eanpietien, the owner-0uulder will have the burden
of proving that he did not build or irprove for the purpose of safe.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of properly who bids or irproves thereon, and who contracts for
such projects with a contractor(s) licensed pursu3W to the Contractors License Law.)
❑ 1 am exempt under Sec_ w_ b P_C_ for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, tabor Code.)
Policy No Company
O Copy is filed with the city_ ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 9 the pend is for one hundred Wllars ($700) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: 8, after mall g this Certificate of Exemption you should become
subject to the Workers' compensation provaions of the Labor Code, you must forthwith
comply with such provisions or this peri shall be dammed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec_ 3097. Ori Code.)
Lender's Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days
I car ity that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes
Signature of
Mailing Addi
City, State,
No. V%71aI
BUILDING: TYPE CONST. OCC. GRP.
Number 613-790-020
Legal Description
Project Description Riiildlnt: 35. P14an 211_ T.Ar 117
I
Sq. Ft. 912
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
r
Estimated Valuation
$65,225
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Z
5.61
Const.
Mech.
Electrical
4A. A
Plumbing
r,
S.M.I.
Grading
Driveway Enc.
Infrastructure
i
fi S 7
r' Pte^ oo-b
.*r
Q �r
TOTAL
S
t
REMARKS
pi f j i } ? $.�s!
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 12/28/8Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FG. SO. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROCK STORAGE
FOUND. REINF. ' Q�
!v
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SO. FT. ®
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
WATER HEATER
URINAL
SO FT ®
BOND BEAM
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/ec
HOUSE SEWER
INSULATIONISOUND3 f
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE ---jCONST.
FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. ' Q�
!v
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
�
/�
/fT
� J
I /^
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL
LATHING
MESH
INSULATIONISOUND3 f
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t